1. Commercial weight management; review of evidence
11 October 2011
Commercial weight management; review of evidence
Insert name of presentation on Master Slide
Presenter: Dr Sarah J Jones

2. Background Overweight and obesity in Wales at 57%
Range 53% to 62% across HBs
Need effective interventions
Lots of gaps in evidence
Moves to develop NHS : commercial partnerships
Commercial weight management; review of evidence

3. Question
Is there evidence of effectiveness of commercial weight management that would support closer links between the NHS and these programmes and, if so, how should such links be managed?
Commercial weight management; review of evidence

4. Approach Scoped inclusion / exclusion criteria
Structure of each programme
NICE guidance
Information about processes of involvement and what influences participation
Outcomes of participation
Clinically important weight loss and maintenance of weight loss
Commercial weight management; review of evidence

5. Programmes reviewed Weight Watchers Jenny Craig Lighter Life
Slimming World
Cambridge
Rosemary Conley
Commercial weight management; review of evidence

6. Realistic target; 5-10% of original weight ?
NICE (2006) guidance
Sl World
J Craig WW
C’bridge
Lighter Life
R Conley
Realistic target; 5-10% of original weight ?
Max. weekly loss 1kg
Long-term change, not short term, quick fix
Diet and physical activity
Balanced, healthy eating
Recommending regular physical activity
Includes keeping a diary, and coping with ‘lapses’ and ‘high-risk’ situations
On-going support
Note: - LighterLife state that for the very obese higher targets are appropriate and they have agreed this with NICE in private discussions. Until NICE makes this public policy, the programme is not regarded as meeting NICE guidance in these areas.
Commercial weight management; review of evidence

7. Commercial weight management; review of evidence
S World
J Craig WW
C’bridge
L’ Life
R’ Conley
Meets NICE good practice guidance?
Yes
Meets some guidance, could not assess all elements No
Research evidence satisfies (CASP) guidance?
No evidence to assess
Sys review reasonable quality, reasonable quality RCT
Moderate quality study
Effective? Clinically significant weight loss?
No evidence of this
Some evidence of clinically sig weight loss at 1 year
Some evidence of clinically sig weight loss at 6 months
Some evidence of clinically sig weight loss
Some evidence of clinically sig weight loss in short term
Weight loss sustained?
No evidence of this
Evidence of weight gain at 2 years
No longer term data
No follow up data
No follow up data
Row 1 – structure, row 2 – process, rows 3 / 4 - outcomes
Commercial weight management; review of evidence

8. Commercial weight management; review of evidence
Programme
Costs
Effectiveness
Cost effectiveness
Other
Jenny Craig
Individual, with support if needed
Current UK fees NK; 1 or 3 yrs paid in advance
1 RCT carried out, funded by Jenny Craig
No good quality evidence of cost effectiveness
60,164 people enrolled for 1yr, 73% retained at 4 wks, 42% at 13 wks, 22% at 26 wks, 7% at 52 wks
Jenny Craig estimated to cost 5 x Weight Watchers
Clinically important weight loss 10% at 1 yr, dropping to 7% by 2 yrs.
Programme is diet, physical activity and behaviour change
Low quality study, lacking info about group assignment and measurement methods.
By 10 wks, 50% of those who had enrolled had dropped out
As April 2011, food and consultations £277 per mth, food only £249 and consultation only £148. Excludes membership fees.
All costs covered for study participants. Very different to 'real world' and the outcomes greater than in community.
Commercial weight management; review of evidence

9. Commercial weight management; review of evidence
Programme
Costs
Effectiveness
Cost effectiveness
Other
Slimming World
Group based, lead by successful member
Membership fee of £10, weekly fee £4.95 (as February 2011)
There is no good quality evidence to demonstrate the effectiveness
No good quality evidence to demonstrate cost effectiveness
12 week study, n=107 GP funded
62 completed 12 weeks (57.9%)
Meetings in community venues, last 1 to 1.5 hours
28 completers used free vouchers (26.2%)
12 weeks attendance would cost £ before the cost of food
35 lost ≥5% body weight (32.7%)
Programme is diet, physical activity and behaviour change
GP endorsement was validation; cost a barrier for some; others preferred to self fund even when free vouchers available
Some men only groups. Some evidence men lose weight using Slimming World
Commercial weight management; review of evidence

10. Commercial weight management; review of evidence
Programme
Costs
Effectiveness
Cost effectiveness
Other
Weight Watchers
Group, lead by previously successful member
Current UK fees (correct as February 2011) ~ £20 per mth; covers joining fee and weekly meetings
3 RCTs, 1 NIH funded, 1 by WW, 1 by BBC
Aus. RCT found WW unlikely to be cost effective
95.3% US lifetime members female; mean BMI 27.6
Meetings in community venues, last about 1 hr
1 study; 3kg weight loss at 12 mths. Not clinically important, not true WW
At 5 years, only 50% maintained 5% weight loss
WW v self help; WW gave fair weight loss at 1 yr, but weight gain by 2 yrs
50% drop out within 6 weeks, 70% within 12 weeks.
Programme is diet, physical activity and behaviour change
BBC trials; 7.3% loss in WW group at 6 mths. No longer term data .
WW highly complex and difficult to follow
Commercial weight management; review of evidence

11. Commercial weight management; review of evidence
Programme
Costs
Effectiveness
Cost eff’ness
Other
C’bridge
Individual, with support
Current weekly costs £36 to £44 to cover formula
No good quality evidence of effectiveness
No good quality evidence of cost eff’ness
No other info
Programme is solely formula diet based
L’Life
Group based
Currently costs £66 per week for the main programme, £49.50 for the Lite version
One L’Life funded RCT
There is no good quality evidence to demonstrate the cost effectiveness of LighterLife
9 /10 users are female
Formula diet based but also includes physical activity and behaviour change
Clinically sig weight loss at 9 mths? No longer term data
?? study quality; no data on group assignment and measurement methods
Half of users are 36 to 54 years
Weekly meetings max.12 single sex participants
V obese popn treated at special clinic; high drop out
R’Conley
Group and individual
Membership fee £10, weekly class costs vary
One RCT
Physical activity and dieting
Clinically sig weight loss at 6 mths; no longer term data
Commercial weight management; review of evidence

12. Summary of findings
Some individuals lose some weight, sometimes a clinically significant amount, in the short term.
Lack of significant, consistent effect in the longer term.
Small amount of research evidence.
Lack of high quality randomised trials and systematic reviews.
Impossible to make definitive statements for specific populations, e.g., people with CVD
Little evidence on the cost effectiveness
Commercial weight management; review of evidence

13. For health professionals
Based on the information collated and appraised it is not possible to recommend any particular commercial weight loss programme on the basis of effective outcomes or compliance with good practice
Two programmes did comply with best practice guidance (NICE), but could not demonstrate longer term effectiveness.
When discussing weight loss with patients, health professionals should consider current NICE guidelines and be able to support patients in making an appropriate choice
Commercial weight management; review of evidence

14. For service planning, policy development
Insufficient evidence to support formal referral schemes between NHS and commercial weight management organisations
Consideration robust evaluation trials.
Review current NHS weight loss service to identify innovative practice, good practice and current gaps in services in relation to need.
Consider producing and disseminating of information to support patient choice of weight management programmes and to support health professionals in providing advice to their patients on the choice of programmes
Commercial weight management; review of evidence

15. Next steps Turn findings into short information sheets?
Put information sheets on Web?
Commercial weight management; review of evidence

16. Acknowledgements Beth Cossins Christian Heathcote – Elliot
Copy of report available on Public Health Wales website
Commercial weight management; review of evidence